Case management of personal injuries
When an injured person has to undergo treatment, rehabilitation or requires care to recover or reach their best level of functioning, it can be an expensive and multifaceted journey. In such cases, it is beneficial to have a qualified person appointed to manage or co-ordinate all the different aspects of care. How does this happen and who can be a Case Manager?
What is case management?
Medical case management is a collaborative process that facilitates recommended treatment plans to assure the appropriate medical care is provided to disabled, ill or injured individuals. It refers to the planning and coordination of health care services to achieve the goal of medical rehabilitation. Case management may include, but is not limited to, care assessment, personal interview with the injured patient, and assistance in developing, implementing and coordinating a medical care plan with healthcare providers, as well as the patient and his/her family and evaluation of treatment results. Case management entails coordinating resources in terms of medical, therapeutic, housing, transport, and adapted equipment etc.
The purpose of case management in general is for the resources (finances, equipment, time and expertise) to be managed as effectively as possible. The aim is to manage the cost of care while providing the injured person with the maximum benefit. Case management has essentially been applied in hospital settings for many years, but in a more informal planning sense, when a doctor outlines a care plan for a patient’s recovery.
Case management is now also used outside the hospital, health schemes and managed health care organisations. It is often utilised in coordination with rehabilitation and vocational (return to work) programmes, where injury on duty, work and non-work related injuries and illnesses impacts a person’s ability to stay at or return to work.
What is a Case Manager?
The professional case manager of today is expected to support the financial bottom line by assisting in the delivery of quality health care. To achieve this, the case manager needs to be appropriately qualified, skilled and experienced in order to deliver the expectation and the value. A case manager is often a clinical practitioner (such as a General Practitioner, Occupational Therapist or other specialist) who is in charge of co-ordination of care as well as the cost.
In South Africa, there are no clearly defined requirements of which persons would be qualified to act as a Case Manager as yet. What is clear, is that the person should have objectively relevant experience and knowledge to co-ordinate a patient’s care.
The Case Manager Association of South Africa (CMASA) is a registered non-profit association, created in 2009, to assist with the promotion of professionalism, ethical values and excellence through education, networking and the collective development of Case Management in South Africa. They aim to establish uniform guidelines in South Africa that will allow case managers to be officially qualified and acknowledged care providers.
Case management in personal injury litigation
For purposes of legal action due to personal injury, case management is more than simply managing “the costs” of client or patient care. More importantly in the medico-legal sense case management assists in the “unseen costs” in terms of the burden of care of the patient on the family and their community. For example, “the costs” financially, emotionally and psychologically on all involved in the care of a patient i.e. parents being unable to work due to caring for their disabled children or family members; caregiver fatigue and burnout; family and social dynamic changes and a host of other unseen costs associated with the burden of care of the disabled.
Having the help of a case manager lightens the load on a possibly overwhelmed patient and their family.
If you have any questions about the viability of case management in your personal injury case, feel free to contact us at Paul du Plessis Attorneys at 012 809 1588 or send an e-mail to paul@pauldup.co.za
Written by
Dané du Plooy
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